Ashcroft Protocols at a Glance
By Pardip Sandhu
Currently our patients are part of shared care – meaning some are managed by hospital and some by us. They need to be separated out with a separate recall. If there is a chronic disease ok to be with this. But important it is separate because some need 6m/3m recall so will need recall separate. The letter and info they receive needs to be different.
- New pt initiated on NOAC (letter/discharge summary/task).
In SystmOne, click NOAC by Junaid template
- Fill in p1 starting NOAC (ignore pt questionnaire)
Guide to adding a recall
• If the pt needs 12mly bloods and there is a chronic disease recall in place add the recall to existing recall
• Highlight chronic disease recall and click amend recall type in ‘NOAC recall- FBC LFT and U&E 12mly
• If there is no chronic disease recall add a NOAC recall- type in ‘12mly fbc LFT and U&E’
- Medication review for a patient on NOAC (page 2 of the template)
• Do HASBLED score The BP and alcohol intake would have been inputted by PN by nurse
• Telephone review for a medication review
• Supersede recall
- Any queries task Dr Pardip Sandhu
By Liz Hamblin
- Pharmacy hub receives a discharge summary with a new antipsychotic medication.
- Look at patient record if the patient is on a mental health register- if yes, do nothing.
- If not on a MH register- send task to nurse admin to add note to existing recall/new recall for bloods and BP
FRACTURES, FRAX & Osteoporosis
By Ramesh Mehay
Go into patient records
WHEN YOU GET A FRACTURE LETTER IN A PATIENT >AGE 50
- Click TEMPLATES – Ashcroft on left hand menu
- Click FRAGILITY FRACTURES BY RAMESH
- Click the little doctor icon at top of template
- Go through page 1 – INITIAL ASSSESSMENT
- Work out whether this is a fragility fracture – may need to ring patient and ask if the fracture was a result of mild impact. (For example, falling down two steps shouldn’t cause a fracture!).
- Use Sheffield Frax Tool link to help you; https://www.sheffield.ac.uk/FRAX/tool.aspx?country=1
- If yes, refer for DEXA scan – do the referral after you have filled in the template
- If you do refer, please arrange a review slot for yourself to look at the scan results and advise the patient.
WHEN THE SCAN COMES BACK
- Go back into template.
- Click on page 2 – BONE SCAN RESULT & DIAGNOSIS
- Only fill in what you can. Don’t worry about anything that you can’t. It should be obvious from the DEXA report.
Then click on page 3 – TREATMENT
- What treatment does the scanned letter advise?
- If diet and exercise – please print out diet/exercise sheet for osteoporosis
- Start Ca Vit D & bone sparing agent (Alendronate) if recommended on the letter. Follow NICE guidelines if unsure.
- Arrange repeat scan 2 yearly